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Evaluates the organizational structure frequently to determine if management positions can be eliminated to reduce the chain of command. 2. Encourages and guides employees to follow the chain of command and counsels employees who do not follow chain of command. 3. Supports personnel in advisory (staff) positions. 4. Models responsibility and accountability for subordinates. 5. Assists staff to see how their roles are congruent with and complement the organizations mission, vision, and goals. 6. Facilitates constructive informal group structure 7. Encourages upward communication 8. Fosters a positive organizational culture between work groups and subcultures that facilitates shared values and goals 9. Promotes participatory decision making and shared governance to empower subordinates 10. Uses committees to facilitate group goals, not to delay decisions 11. Teaches group members how to avoid groupthink Management Functions 1. Continually identifies and analyzes stakeholder Interests in the organization 2. Is knowledgeable about the organizations internal structure, including personal and department authority and responsibilities within that structure 3. Provides the staff with an accurate until organization chart and assists with Interpretation 4. When possible, maintains unity of command 5. Clarifies unity of command when there is confusion 6. Follows appropriate subordinate complaints upward through chain of command. 7. Establishes an appropriate span of control. 8. Is knowledgeable about the organization to meet organizational goals. 9.Uses committee structure to increase the quality and quantity of work accomplished. 10. Works, as appropriate, to achieve a level of operational excellence appropriate to magnet status. CENTRALITY Centrality, or where a position falls on the organizational chart, is determined by organizational distance. Employees with relatively small organizational distance can receive more information than those who are more peripherally located. This is why the middle manager often has a broader view of the organization than other levels of management. A middle manager has a large degree of centrality because this manager receives information upward, downward, and horizontally. TYPES OF ORGANIZATIONAL STRUCTURES LINE STRUCTURES Bureaucratic organizational designs are commonly called line structures or line organizations. Those with staff authority may be referred to as staff organizations. Both of these types of organizational structures are found frequently in large health care facilities and usually resemble Webers original design for effective organizations. Because of most peoples familiarity with these structures, there is little stress associated with orienting people t o these organizations. In these structures, authority and responsibility are clearly defined, which leads to efficiency and simplicity of relationships. Ad Hoc Design The ad hoc design is a modification of the bureaucratic structure and is sometimes used on a temporary basis to facilitate completion of a project within a formal line organization. The ad hoc structure is a means of overcoming the

inflexibility of line structure and serves as a way of professionals to handle the increasingly large amounts of available information. Ad hoc structures use a project team or task approach and are usually disbanded after a project is completed. This structures disadvantages are decreased strength in the formal chain of command and decreased employee loyalty to the parent organization. MATRIX STRUCTURE A matrix organization structure is designed to focus on both product and function. Function is described as all the tasks required to produce the product, and the product is the end result of the function. (For example, good patient outcomes are the product, and staff education and adequate staffing may be the functions necessary to produce the outcome.) The matrix organization structure has a formal vertical and horizontal chain of command. Service Line Organization Similar to the matrix design is service line organization, which can be used in some large institutions to address the shortcomings that the endemic to traditional large bureaucratic organizations. Service lines, sometimes called carecentered organizations, are smaller in scale than a large bureaucratic system. For example, in this organizational design, the overall goals would be determined by the larger organization, but the service line would decide on the processes to be used to achieve the goals. Flat Designs Flat organizational designs are an effort to remove hierarchical layers by flattening the chain of command and decentralizing the organization. In good times, when organizations are financially well off, it is easy to add layers to the organization in order to get the work done, but when the organization begins to feel a financial pinch, they often look at their hierarchy to see where they can cut positions. While there are advantages to a flattened organization, many managers resist such change as it means their work load is greatly increased. In flattened organizations, there continues to be line authority, but because the organizational structure is flattened, more authority and decision making can occur where the work is being carried out. STAKEHOLDERS Stakeholders are those entities in an organizations environment that play a role in the organizations health and performance or that are affected by the organization. Stakeholders may be both internal and external, they may include individuals and large groups, and they may have shared goals or diverse goals. Internal stakeholders, for example, may include the nurse in a hospital or the dietitian in a nursing home. Every organization should be viewed as being part of a greater community of stakeholders. LIMITATIONS OF ORGANIZATION CHARTS The informal structure also has its own leaders. In addition, it also has its own communication channels, often referred to as the grapevine. ADVANTAGES AND LIMITATIONS OF THE ORGANIZATION CHART Advantages Maps lines of decision-making authority Helps people understand their assignments and those of their coworkers Reveals to managers and new personnel how they fit into the organization Contributes to sound organizational structure Shows formal lines of communication Limitations Shows only formal relationships Does not indicate degree of authority May show things are they are supposed to be or used to be rather than as they are Possibility exists of confusing authority with status

Authority - is defined as the official power to act. It is power given by the organization to direct the work of others. A manager may have the authority to hire, fire, or discipline others. Because the use of authority, power building, and political awareness are so important to functioning effectively in any structure. Responsibility is a duty or an assignment. It is the implementation of a job. For example, a responsibility common to many charge nurses is establishing the units daily patient care assignment. Managers should always be assigned responsibilities with concomitant authority. If authority is not commensurate to the responsibility, role confusion occurs for everyone involved. For example, supervisors may have the responsibility of maintaining high professional care standards among the staff. If the manager is not given the authority to discipline employees as needed, however, this responsibility is virtually impossible to implement. Accountability is similar to responsibility, but it is internalized. Thus, to be accountable means that individuals agree to be morally responsible for the consequences of their actions. Therefore, one individual cannot be accountable for another. Society holds us accountable for our assigned responsibilities, and people are expected to accept the consequences of their actions. A nurse who reports a medication error is being accountable for the responsibilities inherent in the position. ORGANIZATIONAL DESIGN Organizational Design refers to the way in which the building blocks of organization ----- authority, responsibility, accountability, information, and rewards ------ are arranged or rearranged to improve effectiveness and adaptive capacity. Organization design and redesign are dynamic, being simultaneously both outcome and process. As outcome, organization design can be represented by the boxes and lines on organization chart. These represent how the building blocks are arranged. As many organizations face increasingly uncertain and rapidly changing environments, new ways of representing organization are emerging, replacing boxes and lines. Intersecting circles, inverted triangles, and lattices are alternative ways of describing the outcomes of design and redesign. Managements Roles in Organization Design Managements primary task is to maintain and improve performance. Often organization design has been thought of as a once and for all event parallel to an architect or engineer designing and constructing a new building. The design process is not carried out in isolation from other management activities. In fact, ideas about the type of design that might be appropriate should be derived from the organizations mission and strategic planning process (Pearce, 1982). For example if the Department of Public Health decides to close down its immunization program, it may be necessary to regroup ongoing services within the organization.

LEVELS OF ORGANIZATIONAL DESIGN LEVELS Individual Positions ILLUSTRATIONS Managers Staff position Health professionals Other workers

Work Groups

Task forces and committees Teams Units and departments Division of two or more units Medical staff organization Hospitals Primary Care Centers Public health units Long-term care facilities Health maintenance organizations (HMOs) Multispecialty group practices Strategic alliances between physicians and health systems Organizations providing services for oncology patients Preferred provider organizations (PPOs) Affiliated groups of hospitals A groups of hospitals under single ownership All home health services in a state A national system of health services An integrated health system

Cluster of Work Groups

Total Organizations

Network of Organizations


TYPES OF ORGANIZATIONAL DESIGN FUNCTIONAL DESIGN- exists when labor is divided into departments specialized by functional area. This kind of design is typical of a NURSING HOME, CHRONIC-CARE FACILITY, OR SMALL (LESS THAN 100 BEDS) COMMUNITY GENERAL HOSPITAL. DIVISIONAL DESIGN - is often found in large academic health science centers (AHSCs) that operate under conditions of high environmental uncertainty exacerbated by relationships with the medical school and high technological complexity because of intensive research activities. (PHARMACEUTICAL COMPANIE AND HEALTH SUPPLIER ORGANIZATIONS where a large variety of products and markets are involved. MATRIX DESIGN - to overcome some of the functional and divisional designs, MATRIX or MIXED DESIGNS have evolved to improve mechanisms of lateral coordination and information flow across the organization. (PSYCHIATRIC CENTER) PARALLEL DESIGN- was originally developed as a mechanism for promoting quality of working life in organizations (Stein & Kanter, 1980). It is responsible for complex problem solving requiring participatory mechanisms. (ACUTE GENERAL HOSPITAL)